- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.40 / $6,907.00 / $28,461.12
| Facility | | $104.40 | $6,907.00 | $28,461.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.65 / $3,925.15 / $5,671.67
| Professional | | $80.65 | $3,925.15 | $5,671.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.05 / $270.37 / $7,164.94
| Professional | | $99.05 | $270.37 | $7,164.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,499.25 / $22,821.15 / $41,203.40
| Facility | | $17,499.25 | $22,821.15 | $41,203.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,003.56 / $6,106.08 / $12,819.66
| Professional | | $5,003.56 | $6,106.08 | $12,819.66 |